Diagnosis of Diabetic Eye Disease

Abstract

To the Editor.— It is interesting to note in the article by Sussman et al (1982;247:3231) and the editorial by Skyler (1982;247:3247) that nonophthalmologists missed the diagnosis of proliferative diabetic retinopathy around 50% of the time under ideal conditions (ie, dilated pupils and no time limit). I believe a more revealing, but difficult study would have been to examine the nonophthalmologists' patients after a routine examination, ie, with the physicians' normal time constraints and examining conditions. Appropriate questions put to the physician dealing with diabetic patients are (1) Did you dilate the pupils? and (2) If not, do you think you did an adequate examination? Why or why not? The answers that seem to be most common are that dilating the pupils takes too long and that it annoys the patient. To respond to the first complaint, the dilating drops could be instilled by a nurse before the examination or